The Sierra Leone FETP Background

Since June 2016, Sierra Leone has strengthened its public health workforce by partnering with the US Centers for Disease Control and Prevention (CDC) to establish the Field Epidemiology Training Program (FETP) with the aim of building the capacity of its public health workforce in surveillance and outbreak investigation and response.

The program is structured under the Ministry of Health and Sanitation Directorate of Health Security and Emergencies with active participation of US CDC’s implementing partners—eHealth Africa and the African Field
Epidemiology Network (AFENET).

Following the 2014-2015 Ebola outbreak in West Africa, the FETP-Frontline was set up with the aim of developing Sierra Leone’ public health workforce ability to apply epidemiological skills to reduce the threat of public health emergencies. To date 127 public healthcare workers from various government institutions, including Ministry of Health and Sanitation, Ministry of Agriculture and Forestry (Animal production unit), Republic of Sierra Leone Armed Forces, Sierra Leone Police, and Sierra Leone Correctional Services have been trained on the FETP-
Frontline course across five cohorts.

In September 2017, FETP-Intermediate was introduced with the aim of strengthening public health surveillance, outbreak investigation and response, and survey data to use for decision making at the middle level of the health system. As part of their Intermediate competencies,
trainees engage in a group project which addresses one of Sierra Leone’s public health concerns. The first cohort of FETP-Intermediate graduated 11 trainees in July 2018.

Key Achievements

Successfully implemented 7 FETP – Frontline Cohorts. Trained 127 public health professionals

National Coverage. Representations from Health, Agruculture, Police and Military sectors.

GHSA goal of one epidemiologist per 200,000 population attained.

The FETP Background

Effective disease detection, investigation, control, and prevention require a public health workforce well-trained in the principles and practice of field epidemiology.

Since 1980, the U.S. Centers for Disease Control and Prevention (CDC) has worked with Ministries of Health (MOHs) throughout the world to establish and support Field Epidemiology Training Programs (FETPs). These programs are recognized worldwide as an effective means to strengthen countries’ capacity in surveillance, epidemiology, and outbreak response.

Health professionals who join FETP are trained to be expert practitioners of field (or applied) epidemiology. Many become leaders and managers in the MOH, improving surveillance systems, strengthening capacity to address emerging and endemic health threats, and promoting a culture of data-driven decision making.

FETPs are field-based, with minimum classroom time and maximum time in the field, providing public health services while participants achieve competency.

Epidemiology

The study of the distribution (e.g. patterns by time, place, and person) and determinants (e.g., causes, risk factors) of health-related states or events in specified human populations and its application to the control of health problems.

Field Epidemiology

The practice of epidemiology in the field (communities); commonly in public health service.

The FETP Three-tiered Pyramid Model

In recent years, CDC and MOHs have recognised the importance of strengthening the capacity of the public health workforce at all levels of the public health system. In response, a three-tiered “pyramid” model of training was developed to improve the surveillance, epidemiology investigation, response, and scientific communication skills of public health workers at each level of the health system.

Program Impact

The program’s impact is two-fold — on the residents and on the MOH. Residents develop competency in the practice of field epidemiology, while the MOH benefits from strengthened surveillance systems, more timely and effective responses,  improved internal and external communication, and more evidence-based decision making and policy development.

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Training Approach

All three tiers use the same approach of limited classroom instruction followed by time in the field to practice the skills learned in the classroom.

Classroom instruction focuses on epidemiologic practice rather than theory, and uses an interactive problem-solving approach, with frequent exercises and case studies to reinforce lecture material.

FETP-Frontline

FETP-Frontline Surveillance Training (FETP-Frontline) is a 3-month in-service program focused on detecting and responding to diseases and events of public health importance or international concern.

Participants learn and practice the fundamental skills used in frontline surveillance including use of case definitions, disease detection and reporting, summarizing of data using simple tables and graphs, case investigation, outbreak investigation and response, surveillance monitoring and evaluation, and data analysis and interpretation for decision making.

Participants spend up to 12 days in three workshops in the classroom; they spend the remaining 8–10 weeks back at their jobs, where they conduct field projects to practice, implement, and reinforce what they have learned. These projects include creating a report with summary tables and charts of the surveillance data routinely collected at their agency; conducting monitoring, evaluation, and feedback visits at some of the reporting sites; performing a health problem analysis; and participating in a case or outbreak investigation.

Participants who successfully complete the program receive a certificate of completion signed by MOH and CDC officials.

FETP-Intermediate

FETP-Intermediate is a 9-11 month in-service program focused on strengthening public health surveillance and promoting use of data for decision making at the middle level of the health system, such as provinces, states, and governorates.

Classroom instruction (8 weeks total, in 5 modules) focuses on surveillance interpretation and analysis, outbreak investigation and response, study design, data entry and analysis in Epi Info, planning and conducting surveys, public health communications, and training and mentorship.

Participants develop these competencies through field projects, including conducting an analysis and presenting results from a group survey. In countries that offer both FETP-Frontline and FETP-Intermediate, participants in the intermediate program may mentor those in the frontline program.

Participants who successfully complete the program receive a certificate of completion signed by MOH and CDC officials.

FETP-Advanced

FETP-Advanced is a 2-year program of training and service for health professionals to learn and gain experience in applied epidemiology through supervised, on-the-job, competency-based training and service.

Since the establishment of the first FETP in Thailand in 1980, more than 50 programs with residents (or trainees) from 70 countries have been launched, resulting in more than 3,600 FETP graduates.

Typically, 20–25% of the 2 years is spent in the classroom. Training focuses on advanced surveillance, outbreak investigation, and epidemiologic methods; design (including protocol development), conduct, and analysis of a planned study of a priority health issue; and written and oral scientific communication.

Residents perform these tasks as field projects, including giving an oral presentation at a national or international scientific conference and submitting a manuscript for publication in a peer-reviewed journal.

In countries that also offer FETP-Frontline- and/or FETP- Intermediate, residents in FETP-Advanced may mentor participants in the other two programs. Residents who successfully complete the program receive a certificate of completion signed by MOH and CDC officials. In some countries, FETP residents may receive a Master’s degree in Public Health or Applied Epidemiology from an affiliated university.

Summary Features of the Three tiers of the FETP Pyramid Model
summary of 3-tier
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